Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals / Avaliação do conhecimento sobre cuidados com a traqueostomia e manejo de complicações precoces entre profissionais de saúde

Abstract Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently. Objectives: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization. Methods: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy. Results: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals. Conclusion: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management.

HIGHLIGHTS Healthcare workers should be well versed in identifying tracheostomy management, its complications and responding accordingly. Doctors and nurses (131 =52%) possessed good knowledge about various aspects of tracheostomy care and management. The poorest scores were regarding cuff pressure (38.9%), suction pressure (39.4%) and first response in tube blockade (31.1%). Higher scores were found in age group 26 to 30 years (54.2%) and those having 1-3 years of clinical experience (41.2%). No statistically significant assoiation of knowledge regarding tracheostomy care was apparent with age, gender or years of practice.

Resumo Introdução: A traqueostomia é um procedimento cirúrgico comumente feito na prática otorrinolaringológica. O cuidado pós-operatório é o aspecto mais importante para alcançar bons resultados para o paciente. A indisponibilidade de diretrizes padrão para o manejo da traqueostomia e o treinamento inadequado podem tornar complexa essa prática básica. A equipe de enfermagem e os médicos desempenham um papel muito importante no manejo à beira do leito, tanto na enfermaria quanto na unidade de terapia intensiva (UTI). Portanto, é crucial que todos os profissionais de saúde diretamente envolvidos na prestação de cuidados pós-operatórios a esses pacientes possam fazer isso de forma eficiente. Objetivo: Avaliar o conhecimento sobre a identificação e manejo de emergências relacionadas à traqueostomia e complicações precoces entre os profissionais de saúde, a fim de melhorar a prática e sua padronização. Método: Estudo observacional transversal que incluiu 254 médicos e enfermeiras de quatro grandes hospitais terciários. As perguntas foram simples e diretas em relação à aspiração da traqueostomia, cuidados com o cuff, manejo do cuff, obstrução da cânula e manejo da alimentação em pacientes traqueostomizados. Resultado: Com base nas evidências de nosso estudo, o nível de conhecimento sobre os cuidados com a traqueostomia varia de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios. Existem lacunas significativas no conhecimento em vários aspectos dos cuidados e manejo da traqueostomia entre os profissionais de saúde. Conclusão: Nossos achados demonstraram um nível de conhecimento adequado entre os profissionais de saúde, variação de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios e revelaram que ainda existem lacunas no conhecimento em vários aspectos do tratamento e manejo do paciente traqueostomizado.

DESTAQUES Profissionais de saúde devem estar bem familiarizados com a identificac¸ão do manejo da traqueostomia, suas complicac¸ões e como agir de acordo com a necessidade. Médicos e enfermeiras (131 = 52%) possuíam bons conhecimentos sobre vários aspectos dos cuidados e manejo da traqueostomia. Os piores escores foram em relac¸ão à pressão adequada do cuff (38,9%), à pressão de aspirac¸ão adequada (39,4%) e primeiros socorros em caso de obstruc¸ão da cânula (31,1%). Os melhores escores foram encontrados no grupo 26 a 30 anos (54,2%) e aqueles com experiência clínica de 1-3 anos (41,2%). Não houve associac¸ão estatisticamente significante entre o conhecimento sobre os cuidados com a traqueostomia, idade e gênero e os anos de prática de médicos e enfermeiras.

Percutaneous non-stenting approach for distal simultaneous multivessel acute coronary occlusions

The occurrence of distal coronary lesions causing simultaneous occlusion of two coronary arteries in the setting of ST elevation myocardial infarction is a rare occurrence. This can occur due to simultaneous plaque rupture at more than one site or embolisation in coronary arteries. We describe a case of a middle-aged man who presented with acute inferoposterior lateral wall ST elevation myocardial infarction with simultaneous occlusion of distal left anterior descending artery and distal left circumflex artery on angiogram. The patient was treated with intracoronary streptokinase, followed by glycoprotein [GP] IIb/IIIa inhibitor and Factor X inhibitor [Rivaroxaban] with full resolution of flow in the distal vessels. Thus, coronary lesions, not amenable to stenting, can be dealt percutaneously, using a combination of old and newer pharmacological agents without stenting

Anti-hypercholesterolemic and anti-hyperglycaemic effects of conventional and supercritical extracts of black cumin (Nigella sativa)

Objective To explore the hypoglycaemic and hypocholesterolemic potential of conventional and supercritical extracts of black cumin. Methods Purposely, rat modelling was carried out for 2 months by designing three studies i.e. study I (normal rats), study II (hyperglycaemic rats) and study III (hypercholesterolemic rats). Each study was further divided into three groups based on diet i.e. control, functional diet (contained extract of black cumin prepared by using conventional solvent) and nutraceutical diet (contained extract of black cumin prepared by supercritical fluid extraction system). Results During whole trial, an abating trend was observed in the level of serum cholesterol with maximum reduction (12.8%) in nutraceutical group of study III. Low density lipoprotein and triglyceride level was also lowered maximum in study III as 17.1% and 11.6%, respectively. Whereas, highest decline in glucose level was in nutraceutical group of study II as 11.2%. Conclusions Inclusion of black cumin extracts in diet significantly lowers the occurrence of hyperglycaemia and hypercholesterolaemia. Furthermore, hypoglycaemic and hypocholesterolemic potential of nutraceutical diet is more prominent as compared to functional diet.

multiparous woman with lately diagnosed multilevel left ventricular obstruction

A 56-year hypertensive, multiparous woman presented to the cardiology unit with Canadian Cardiovascular Society [CCS] class-III angina and worsening dyspnea for the past few weeks. Her clinical examination showed high blood pressure and mid-systolic crescendo-decrescendo murmur radiating to carotids. However, there was no radio-femoral delay or significant blood pressure difference between her arms. Her transthoracic echocardiography [TTE] revealed moderate aortic stenosis [AS] and mid cavity left ventricular outflow [LVO] obstruction. Left heart catheterization [LHC] showed coarctation of aorta with extensive collaterals, mid cavity LVO obstruction, and moderate AS. Thus, she was diagnosed as a case of multi-level LVO obstruction including mid cavity LVO obstruction AS and coarctation of aorta. She underwent stenting of aortic coarctation as the initial step of graded approach to her disease, and is doing well

Injection sclerotherapy versus rubber band ligation for second degree hemorrhoids

Objective: To compare the efficacy of injections Sclerotherapy [IST] and rubber band ligation [RBL] for the treatment of 2nd degree haemorrhoids in terms of improvement in symptoms severity score [SS score] in OPD patients

Study Design: Randomized controlled trial

Place and Duration of Study: It was conducted in surgical OPD of CMH Kohat, from 15th October 2010 to 10th April 2011

Material and Methods: A total of 116 patients with symptomatic 2nd degree haemorrhoids were randomly divided into two groups, RBL and IST [58 patients each] respectively and a baseline symptoms severity score was noted for each patient. Patients in RBL group were treated with RBL while in IST group were treated with IST. The outcome measures were relief of symptoms and improvement in SS score

Results: In RBL group, baseline SS score was 4.67 +/- 2.01 which reduced to final mean SS score of 1.34 +/- 0.96 whereas in IST group the baseline SS score was of 4.31 +/- 2.13 which reduced to a final mean SS score of 1.6 +/- 0.97. 44 [75.95%] patients had complete recovery and control of bleeding in RBL group; whereas in IST group 32 [55.1%] of the patients had this response by the end of two weeks

Conclusion: Rubber band ligation was found to have better patient outcomes as compared to injections sclerotherapy in treatment of 2nd degree hemorrhoids

Comparative hypoglycemic activity of different fractions of Thymus serpyllum L. in alloxan induced diabetic rabbits

The aim of present study was to evaluate and compare the hypoglycemic activity of different solvents extracts of Thymus serpyllum in rabbits. Diabetes was induced with single intravenous injection of alloxan monohydrate [150mg/kg]. Glibenclamide and acarbose were used as standard drugs. The crude powder of Thymus serpyllum [500 mg/kg b.w] significantly reduced blood glucose level in both normal and diabetic rabbits. Various extracts of Thymus serpyllum were compared for their hypoglycemic activity in diabetic rabbits. Ether and aqueous extracts significantly reduced the blood glucose level with maximum effect [p<0.001] produced by aqueous extract, which was selected for further study. Aqueous extract significantly inhibited the rise in glucose level in oral glucose tolerance test. The extract showed synergistic effect with different doses of insulin; however serum insulin level of the diabetic rabbits was not significantly increased by the extract. HbA1c level was significantly [p<0.05] reduced whereas hemoglobin level was significantly increased in three months study. Phytochemical screening of the aqueous extract showed the presence of alkaloids, flavonoids, tannins, terpinoids, reducing sugar and cardiac glycosides. It is concluded that the aqueous extract might be used alone or in combination with insulin to manage diabetes and its associated complications

Comparison of early oral feeding and conventional oral feeding in cases of elective intestinal stoma reversal in terms of number of days of nasogastric decompression and hospital stay

Objective: To compare the efficacy of early oral feeding and conventional oral feeding in elective intestinal stoma reversal in terms of mean number of days of NG tube out and hospital stay. Study Design: Randomized Controlled Trials. Settings: Surgical Units of Allied/DHQ hospitals Faisalabad. Duration of Study: 1 year duration from February 2014 to January 2015. Sampling Technique: Non-probability consecutive sampling

Methodology: 60 patients were selected from OPD. Patients were randomly allocated to two groups. All stomas were closed in single layer extramucosal seromuscular fashion, intraperitonealy. In post-operative period, patients in group I were allowed oral feed in early post-operative period [6-8 hours] after the surgery. Initially, oral liquids [30ml/hr] was given and patients were observed for nausea and vomiting. Oral feed was increased gradually with the response of the patient with semi-solid to solid diet on 1[st] or 2[nd] post-operative day. Patients in group II were started oral sips of liquids once they pass flatus or audible bowel sounds. At least two follow up visits were advised within two weeks of discharge of patients, 1[st] on the 7[th] day and 2[nd] on the 14[th] day, for removal of skin stitches

Results: Out of 60 patients 37 [61.7%] were males and 23 [38.3%] were females. Among the variables under the study, for both groups, the minimum total number of days of nasogastric decompression was 0 days and maximum total number of days of nasogastric decompression was 5 days with mean of 1.17 days and standard deviation of 1.33. In group 1, the mean of the total number of days of nasogastric decompression was 0.13 +/- 0.35 days and in group 2, the mean of the total number of days of nasogastric decompression was 2.20 +/- 1.13 days with p-value of 0.0001 for both the groups, the minimum total number of days of hospital stay was 3 days and the maximum was 9 days, with mean of 4.82 days and Std. Deviation of 1.70 days. In group 1, the mean of the total number of days of hospital stay was 3.37 +/- 0.61 days and in group 2 the mean of the total number of days of hospital stay was 6.27 +/- 1.08 days with p-value of 0.000

Conclusion: Early oral feeding in cases of elective intestinal stoma reversal is better than conventional oral feeding in terms of number of days of nasogastric decompression and hospital stay

Virtual screening for potential COX-inhibiting constituents from Mimosa pudica.

Developing a new agent in the anti-inflammatory and analgesic field, plants secondary metabolites can be a good source for the Non-Steroidal Anti-inflammatory Drugs (NSAID) drug development. For this purpose we subjected the active compounds of Mimosa pudica Linn. to reveal its potentiality by molecular docking analysis to find out its potent compound against COX which was done by GOLD docking analysis. Docking studies by GOLD showed that vitexin of Mimosa pudica had the highest fitness score against the COX-1 which is 60.43 and 63.49 for COX-2 enzyme. Vitexin of Mimosa pudica detected with significant fitness score and hydrogen bonding against COX-1 and COX-2 which may be a potent analgesic compound.

Evolution of selective COX-2 inhibitor from Alangium salvifolium: an in silico approach.

Pain and inflammation are linked with a number of pathological conditions. Several studies are in progress worldwide to find natural healing agents with better safety profile. Our current study was aimed to evaluate Alangium salvifolium (family: Alangeaceae) derived analgesic compounds for therapeutic drug discovery by computational approach. Literature based studies were used to explore the compounds of A. salvifolium. Ligands were prepared by following the appropriate procedures and finally in silico molecular docking analysis performed by GOLD 4.2. After post docking analysis, salviifosides A of Alangium salvifolium was found to have interaction on COX-2 protein by obtaining highest fitness score 50.64 and molecular interaction suggests that it could be a potent anti-inflammatory compound and it may be worth for further clinical trials.

Cardiotonic and vasoconstriction effects of aqueous methanolic extract of Paspalidium flavidum L.

The cardiovascular activity of aqueous methanolic extract of Paspalidium flavidum L. was evaluated on isolated rabbit heart and aorta. Heart rates, force of contraction and perfusion pressure were assessed in the presence of different concentrations of extract and adrenaline by using Langendorff's technique. Moreover, the vasoconstriction effects were studied in rabbit aorta using isolated organ bath. The results indicated that the extract [1ng-100[micro]g/ml] exhibited a significant increase in heart rate, contractility and perfusion pressure of isolated rabbit's heart; with a maximum effect at 1ng/ml, which was comparable to adrenaline [1[micro]g/ml]. Similarly, adrenaline at doses from 1-10[micro]g/ml produced a significant dose dependant increase in all the cardiac parameters. The cardiotonic effects of the extract were significantly blocked by propranolol [10[-5]M] while an increase in perfusion pressure was completely antagonized by verapamil [10[-6]M]. Activity of cardiac marker enzymes was also significantly raised in the perfusate of isolated heart pretreated with the extract. In rabbit aorta, the extract exhibited a dose dependent vasoconstriction effect however it did not increase the tone of aorta when pre-treated with verapamil [10[-6]M]. It is conceivable therefore; that the cardiotonic and vasoconstriction effects of the extract might be due to its agonistic actions on beta-receptors and Ca[+2] channels

Effect of toothpaste in reducing dentine hypersensitivity

The present study was conducted at Khyber College of Dentistry during the year 2014 with the aim to investigate dentine hypersensitivity [DH], one of an unpleasant condition experienced by young to middle age people which restricts the daily drinking/eating habits of patients. For this purpose fifty patients [25 male, 25 female] were randomly selected and examined for sensitivity. The patients were divided in to 2 groups i.e. treatment [Sensodyne Rapid action tooth paste] and control [Colgate total care tooth paste]. The patients were given blast of air for 10 seconds and tooth sensitivity was evaluated by Visual analogue scale. Statistical analysis of the data revealed that all of the subject patients had DH due to periodontal problem/attachment loss. Results indicated that regular use of desensitizing tooth paste drastically reduced dentine hypersensitivity when compared to the daily use tooth paste [control]

Effect of obesity on periodontal disease

The present study investigates the effect of obesity on periodontal diseases. For this purpose a sample of 80 subjects [20-50 years age] was collected at the Department of Periodontology, Khyber College of Dentistry [KCD] during July 2015 to September 2015. The periodontal examination consisted of Pocket probing depth [PPD], Clinical attachment level [CAL]. Body mass index [BMI] and Waist Circumference [WC] were used as obesity indicators. The data indicated significant relation of BMI and WC with CAL in obese group as compared to non-obese .The results also suggested that the overall and abdominal obesity were associated with extent of periodontal disease in sample of patients studied

In vivo analgesic, antipyretic, and anti-inflammatory potential in Swiss albino mice and in vitro thrombolytic activity of hydroalcoholic extract from Litsea glutinosaleaves

BACKGROUND: The study was conducted to evaluate the in vitro thrombolytic activity, and in vivo analgesic, anti-inflammatory and antipyretic potentials of different hydrocarbon soluble extracts of Litsea glutinosaleaves for the first time widely used in the folkloric treatments in Bangladesh. This work aimed to create new insights on the fundamental mechanisms of the plant extracts involved in these activities. RESULTS: In thrombolytic activity assay, a significant clot disruption was observed at dose of 1 mg/mL for each of the extracts (volume 100 µL) when compared to the standard drug streptokinase. The n-hexane, ethyl acetate, chloroform, and crude methanolic extracts showed 32.23 ± 0.26, 37.67 ± 1.31, 43.13 ± 0.85, and 46.78 ± 0.9% clot lysis, respectively, whereas the positive control streptokinase showed 93.35 ± 0.35% disruption at the dose of 30,000 I.U. In hot plate method, the highest pain inhibitory activity was found at a dose of 500 mg/kg of crude extract (15.54 ± 0.37 sec) which differed significantly (P <0.01 and P <0.001) with that of the standard drug ketorolac (16.38 ± 0.27 sec). In acetic acid induced writhing test, the crude methanolic extract showed significant (P <0.01 and P <0.001) analgesic potential at doses 250 and 500 mg/kg body weight (45.98 and 56.32% inhibition, respectively), where ketorolac showed 64.36% inhibition. In anti-inflammatory activity test, the crude methanolic extract showed significant (P <0.001) potential at doses 250 and 500 mg/kg body weight (1.51 ± 0.04 and 1.47 ± 0.03 mm paw edema, respectively), where ketorolac showed 1.64 ± 0.05 mm edema after 3 h of carrageenan injection. In antipyretic activity assay, the crude extract showed notable reduction in body temperature (32.78 ± 0.46°C) at dose of 500 mg/kg-body weight, when the standard (at dose 150 mg/kg-body weight) exerted 33.32 ± 0.67°C temperature after 3 h of administration. CONCLUSIONS: Our results yield that the crude hydroalcoholic extract has better effects than the other in all trials. In the context, it can be said that the leaves of L. glutinosa possess remarkable pharmacological effects, and justify its traditional use as analgesic, antipyretic, anti-inflammatory, and thrombolytic agent.

Genetic polymorphisms of GSTM1, GSTP1 and GSTT1 genes and lung cancer susceptibility in the Bangladeshi population

Objective: To verify possible associations between polymorphisms of glutathione S-transferase Mu (GSTM1), glutathione S-transferase θ (GSTT1) and glutathione S-transferase Pi (GSTP1) genes and susceptibility to lung cancer. Methods: A total of 106 lung cancer patients and 116 controls were enrolled in a case-control study. The GSTM1 and GSTT1 were analyzed using PCR while GSTP1 was analyzed using PCR-restriction fragment length polymorphism. Risk of lung cancer was estimated as odds ratio at 95% confidence interval using unconditional logistic regression models adjusting for age, sex, and tobacco use. Results: GSTM1 null and GSTT1 null genotypes did not show a significant risk for developing lung cancer. A significantly elevated lung cancer risk was associated with GSTP1 heterozygous, mutant and combined heterozygous+mutant variants of rs1695. When classified by tobacco consumption status, no association with risk of lung cancer was found in case of tobacco smokers and nonsmokers carrying null and present genotypes of GSTM1 and GSTT1. There is a three-fold (approximately) increase in the risk of lung cancer in case of both heterozygous (AG) and heterozygous+mutant homozygous (AG+GG) genotypes whereas there is an eightfold increase in risk of lung cancer in cases of GG with respect to AA genotype in smokers. Conclusions: Carrying the GSTM1 and GSTT1 null genotype is not a risk factor for lung cancer and GSTP1Ile105Val is associated with elevated risk of lung cancer.

Comparison of outcome in reamed versus unreamed nailing in the treatment of tibial diaphysial fracture

Background: Tibial diaphysial fractures are among the notorious fractures as far as management is concerned

Objective: To compare the outcome [union] between reamed and unreamed nailing in transverse tibial diaphysial fractures

Patients and Methods: Study Design: Experimental study. Setting: Department of Orthopaedic Surgery, Bahawal Victoria Hospital Bahawalpur. Study Duration: 8 months from 1[st] January 2009 to 31[st] August 2009. Study subjects: 210 patients were divided into two groups A and B. Group A patients were managed by reamed interlocking nail tibia and group B patients by unreamed interlocking nail tibia. Follow up was done up to 3 months and outcome in terms of union was compared between two groups. 15 patients in each group were lost to followup so data analysis was done on 180 patients. Union was achieved in 80% of patients in group A while 70% in group B. Our study suggests that reamed interlocking nail tibia is better treatment option than unreamed interlocking nail tibia

Effects of Antipsychotics on the Inflammatory Response System of Patients with Schizophrenia in Peripheral Blood Mononuclear Cell Cultures

OBJECTIVE: We investigated the effects of antipsychotics on immune-challenged peripheral blood mononuclear cell (PBMC) cultures. METHODS: Blood samples were collected from twelve patients with first-episode schizophrenia. The PBMCs were separated and cultures were prepared and stimulated with lipopolysaccharide (LPS) or polyinosinic:polycytidylic acid (poly[I:C]), and then separately treated with a typical antipsychotic (haloperidol) or atypical antipsychotic (clozapine, quetiapine, or risperidone). Pro-inflammatory (interferon gamma [IFN-gamma]) and anti-inflammatory (interleukin [IL]-4 and IL-10) cytokine levels were measured in the LPS- or poly(I:C)-stimulated PBMC cultures treated with antipsychotics. RESULTS: Haloperidol and quetiapine significantly increased the IL-4 levels (p<0.05) in LPS-stimulated PBMC cultures, while clozapine and quetiapine significantly enhanced the IL-4 levels (p<0.05) in poly(I:C)-stimulated PBMC cultures. Only treatment with haloperidol resulted in a significant increase in IL-10 production (p<0.05) in LPS-stimulated PBMC cultures, whereas clozapine, quetiapine, and risperidone treatment significantly increased IL-10 production (p<0.05) in poly(I:C)-stimulated PBMC cultures. All of the antipsychotics reduced the IFN-gamma level significantly (p<0.05) in LPS- and poly(I:C)-stimulated PBMC cultures. CONCLUSION: Antipsychotic treatment altered immune function by raising the levels of anti-inflammatory cytokines (IL-4 and IL-10) and suppressing the levels of pro-inflammatory cytokines (IFN-gamma).

Cardiotonic activity of methanolic extract of Saussurea lappa Linn roots

The cardiac activity of Saussurea lappa roots was evaluated in isolated perfused rabbit heart by the Langendorff's technique. Heart rate, contractility and coronary flow were determined in the presence of different concentrations of methanolic extract of Saussurea lappa, digoxin and diltiazem. The extract exhibited significant [p<0.01] positive inotropic effect at the first three doses [0.5/ Micro g, 2.5/ Micro g and 5.0/ Micro g] while a significant negative chronotropic effect and coronary flow rates were observed at all the doses tested. These effects were comparable to the effects of digoxin and diltiazem. The increase in force of contraction with decrease in heart rate and coronary flow rates were also observed to be dose dependent as increase in the dose of test extract further enhanced the effects except contractility that started decreasing at higher doses. It is conceivable therefore, that Saussurea lappa roots contain certain pharmacologically active compounds that could be involved in the cardiotonic activity of the extract

Tubeless percutaneous nephrolithotomy; analgesia requirement in conventional and tubeless percutaneous nephrolithotomy: a comparison

Revolutionary advances in the minimally invasive and non invasive management of stone disease over the past two decades have greatly facilitated the removal of stones. Renal stone management moved from open surgery to minimally invasive procedures with the aim of achieving maximum stone clearance with the least morbidity and mortality. Percutaneous nephrolithotomy [PCNL] remains the most efficient procedure in all patient groups. Tubeless PCNL is increasing in popularity and the technique of percutaneous nephrolithotomy is in constant evolution. Nephrostomy tube has been implicated in causing postoperative discomfort or pain and morbidity. Nephrostomy-free or tubeless PCNL reduces postoperative pain and analgesia related to the drainage tube. To compare mean analgesia requirement with tubeless PCNL and standard PCNL in renal stone patients Randomized controlled trial conducted at Shaikh Zayed Hospital Lahore from July 2010 to January 2011. 100 patients were divided into two groups randomly by using random numbertables i.e. 50 patients in group A and 50 patients in group B. Group A patients were operated by standard PCNL method i.e. with Placement of nephrostomy tube and ureteric catheter and group B were operated by tubeless PCNL i.e. without nephrostomy tube but with ureteric catheter. The data was collected on attached predesigned computer based proforma. The analgesic dose requirement in Group A was 116.50 +/- 26.55mg and analgesic dose requirement in Group B was 73.00 +/- 30.24mg of pethidine. So, analgesia requirement in both groups showed a significant difference [p<0.05]. Tubeless PCNL can be used with a favorable outcome in renal stone patients, with the potential advantage of decreased analgesia requirement